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General NPI Number Information
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NPI Number | 1356374912
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Entity Type | Organization
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Legal Business Name | DERMATOPATHOLOGY ASSOCIATES, PLLC
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Dates
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Enumeration Date | 07/08/2006
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Last Update Date | 08/29/2024
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Provider Practice Location Address
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Address Line | 3120 OLD CANTON RD
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City | JACKSON
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State | MS
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Zip | 39216
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Country | US
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Telephone | 601-362-9851
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Fax | 601-982-9025
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Provider Business Mailing Address
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Address Line | PO BOX 3528
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City | JACKSON
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State | MS
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Zip | 39207-3528
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Country | US
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Telephone | 601-362-9851
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Fax | 601-982-9025
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Authorized Official
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Title or Position | MEMBER
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Name | BUU T DUONG
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Credential | MD
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Telephone | 601-362-9851
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number | 25D0688888
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License Number State | MO
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